Trochanteric support plate with Dynamic Hip Screw, is this combination a feasible option in unstable trochanteric fractures?
Background: Dynamic Hip Screw (DHS) is the gold standard for stable trochanteric fractures and Proximal Intramedullary nail (IMN) is beneficial in treating intertrochanteric femur fractures with comminution and loss of lateral buttress. DHS augmented with trochanteric support plate can buttress the broken lateral trochanteric wall. Thus we conducted this study is to evaluate the role of the trochanteric support plate (TSP) with DHS in unstable trochanteric fractures.
Materials & Methods: 25 patients presenting with unstable trochanteric fractures treated with TSP with DHS were evaluated for intraoperative blood loss and duration of surgery. Functional outcome was assessed as per the Kyle's Criteria, Harris Hip Score, and ambulatory outcome.
Results: 21 patients with mean age of 67.14 years were available for study. The mean duration of surgery and blood loss was 100.5 minutes and 312 ml, respectively. All fractures, except 1 united. Nonunion occurred in 1 case due to screw cut out. Af final followup, all patients had excellent to good harris hip score and 91% had excellent Kyle’s criteria, while 9% had good Kyle’s criteria.
Conclusion: The DHS with trochanteric support plate is an acceptable alternate device for managing unstable intertrochanteric fractures with broken lateral wall. It’s an easy, low cost, easily available and less demanding surgical procedure giving excellent results.
Trikha V, Rastogi S. Epidemiology and rehabilitation of hip fractures in the geriatric population. Int J Phys Med Rehab. 2005 Apr;16(1):16-9.
Hall SE, Williams JA, Senior JA, Goldswain PR, Criddle RA. Hip fracture outcomes: quality of life and functional status in older adults living in the community. Intern Med J. 2000 Jun 1;30(3):327-32.
Sidorowicz J, Gaździk T, Jaworski JM. Conservative treatment of trochanteric fractures in the elderly. Wiad Lek. 1998;51(9-10):419-23. (article in polish)
Siu AL, Penrod JD, Boockvar KS, Koval K, Strauss E, Morrison RS. Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med. 2006 Apr 10;166(7):766-71.
Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip. Bone Joint J. 2017 Jan 1;99(1):128-33.
Mittal R, Banerjee S. Proximal femoral fractures: principles of management and review of literature. J Clin Orthop Trauma. 2012 Jun 30;3(1):15-23.
Mokawem M, Bobak P, Aderinto J. The management of pertrochanteric fractures of the hip. Orthop Trauma. 2012 Apr 30;26(2):112-23.
Kumar R, Singh RN, Singh BN. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma. 2012 Jun 30;3(1):28-36.
O'Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S. Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study. Canadian J Surg (J canadien de chirurgie) 1995 Dec;38(6):516-20.
Penugonda RS, Vanga A, Gangireddi S, Seetam RS. Comparative study between proximal femoral nailing and dynamic hip screw in the management of intertrochanteric fractures of femur. J Evid Based Med Healthc. 2015 Feb 2;2(5): 541-50.
Page PR, Lord R, Jawad A, Dawe E, Stott P, Rogers B, Gill R. Changing trends in the management of intertrochanteric hip fractures – A single centre experience. Injury. 2016 Jul 31;47(7):1525-9.
Gupta RK, Sangwan K, Kamboj P, Punia SS, Walecha P. Unstable trochanteric fractures: the role of lateral wall reconstruction. Int Orthop. 2010 Jan 1;34(1):125-9.
Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Strømsøe K. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 1998 May 1;12(4):241-8.
Babst R, Martinet O, Renner N, Rosso R, Bodoky A, Heberer M, Regazzoni P. The dynamic hip screw support plate for management of unstable proximal femoral fractures. Helv Chir Acta. 1993 Mar;59(4):521-5.
Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res. 2004 Aug 1;425:82-6.
Geissler N, Meffert O, Stapel A, Heymann H. Results of surgical management of unstable pertrochanteric femoral fractures with the dynamic hip screw and T-plate. Unfallchirurgie. 1994 Apr;20(2):72-5.
Hsu CE, Chiu YC, Tsai SH, Lin TC, Lee MH, Huang KC. Trochanter stabilising plate improves treatment outcomes in AO/OTA 31-A2 intertrochanteric fractures with critical thin femoral lateral walls. Injury. 2015 Jun 30;46(6):1047-53.
Ghattas PJ. Objective measures for estimating intraoperative blood loss. In 2012 Ann Meet Am Osteopathic Aca Orthop. Colorado Springs, Colorado 2012 Oct (pp. 25-28).
Corrales LA, Morshed S, Bhandari M, Miclau III T. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008 Sep 1;90(9):1862-8.
Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. Orthop Trauma Directs 2010 Nov;8(6):25-9.
Kempf I, Grosse A, Taglang G, Favreul E. Gamma nail in the treatment of closed trochanteric fractures. Results and indications of 121 cases. Revue de chirurgie orthop et reparatrice de l'appareil moteur. 1993;79(1):29-40.
Cho SH, Lee SH, Cho HL, Ku JH, Choi JH, Lee AJ. Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO type 31-A2): short-term clinical results. Clin Orthop Surg. 2011 Jun 1;3(2):107-13.
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